HomeMy WebLinkAboutPermit Electrical 1999-9-3
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NOTICE:
ELECTRICAL PERMIT APPLICATION
91/2/8'
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769 THISPERMITSHALlEXPIRElfl:M~VO~~ber
OFFICE: 726-3759 AUTHORIZEDllNDI';/;l-
. 3'. 't;ui!P~ffRMlEI$~ULE BELOII
l..I~LOCAT.J.QN OF INSTALlJ>.Tj9N COMMENCED OR IS ABANDONED FOR .
~gg t::./.bewhg~I2Y ";)mlft::IANY1Ari~YPERIC~W Residentlal-Single or
LfIJ/h1ii)~11rn07l f.\{jlti-Family per dwelling unit.
LEGAL DESCRIPTION ._.~,- . Service Included:
Items
,
tAL~11
#tf'f
1000 sq.ft. or less
Each additional 500
. sq. ft or portion
Permi ts are non-transferablePlrid:1ekpireJ ~~. ".~,thereof
if work is not started wi thiffi~"180Uaaysj(lO'I''' bv E!,c'h."Hanuf'd Home. or
of issuance or if work is ~(isp'ended (f.Ot;€r. T'lcc .Mojlu~.~r'Dwelling
180 days. rnOAR952.0D1-00HJ""'1 SerVlce'or Feeder
0090 Y . IU J", .~'4,.., ','o".c. .
. oumayobtalncop", "'.", ..
2. CONTRACTOR INSTALLATION O!'!J.;);g the center. P""'E~~~V?~~s'l?rFeeders .
L JI1 IlI\mt4eOL"'h"(1r. ... InstaN'at.lon, Alteratlons
Electrical Contractor ." .O~/"P..(L@1;'1WeUo'i-\R'eJJoca1tion:
/ f "I I' /l " ~ L-. . .. . - ."HII(j..13~' .' 4~ \.
Address~ ~. t{ ~r(. 200 amps or less
s: ,/1 if . /21) 201 amps to 400 amps
Ci ty PnD ..177- 7 7 Phone 7~ 7'~IP;./tJ . 401 amps to 600 amps
~ 601 amps to 1000 amps
SupeL'visor License Number /tf7.35 Over 1000 amps/volts
/'()I/~/'/AI Reconnect Only
Expiration Date t' Iv Iv
JOB D~SC!Q:PTION _ L
rN'5T111L 71<lrN5FeJe SUJlnr/e5
Cost
Sum
$ 85.00
$ 15.00
.$ 40.00
I
$ 50.0050. -
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr. Number tJJb1'1
Expiration Date 12// J/~IJ
/
Signature of Supervising Electrician
Y." ~-L/~
Owner~ t::ei!1l:iA tJF ~!fGe}/glAJ.t<!rfJ.D.
Address 4ft) It Vs;/L Ave:
Ci tlf'tu:f&VEf" C; 7~1-rhone (;;22- .$60D
I
OIlNER INSTALLATION
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see liB" above'
.'
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E.
Ovners Signature:
-----~--- - -, -~----,--------------------
DATE: . 't 3 if,
RECEIPT : Ii S f""1'f ~ " jI .
RECEIVED BY: d ftJIoi"
5. SUBTOTAL OF ABOVE
7.8Y. State Surcharge
3% Administrative Fee
TOTAL
$ 35.00
$ 2.00
not included)
$ 40.00'
$ 40.00
$ 20.00
$ 36.00
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